<!-- YOU CAN REMOVE THE STYLE BELOW -->
<style>
p{padding:0;margin:0;}
body{padding:0;margin:0;}
</style>
<!-- STYLE ONLY FOR DEMO - REMOVE -->

<form action="mail.php" method="POST">
<p>Name</p> <input type="text" name="name">
<p>Email</p> <input type="text" name="email">
<p>Phone</p> <input type="text" name="phone">

<p>Request Phone Call:</p>
Yes:<input type="checkbox" value="Yes" name="call"><br />
No:<input type="checkbox" value="No" name="call"><br />

<p>Website</p> <input type="text" name="website">

<p>Priority</p>
<select name="priority" size="1">
<option value="Low">Low</option>
<option value="Normal">Normal</option>
<option value="High">High</option>
<option value="Emergency">Emergency</option>
</select>
<br />

<p>Type</p>
<select name="type" size="1">
<option value="update">Website Update</option>
<option value="change">Information Change</option>
<option value="addition">Information Addition</option>
<option value="new">New Products</option>
</select>
<br />

<p>Message</p><textarea name="message" rows="6" cols="25"></textarea><br />
<input type="submit" value="Send"><input type="reset" value="Clear">
</form>

